Reporting Abuse to Law Enforcement and the Medicaid Fraud

5330 - Reporting Abuse to Law Enforcement and the Medicaid Fraud Control Unit for Nursing Homes (Rev. 243; Issued: 06-12-26; Effective: 06-12-26; Implementation: 06-12-26) If the SA receives information that a suspected crime may have occurred in a facility and there is indication that it has not been reported or the SA cannot verify that a report was made to law enforcement, the SA must report the suspected crime to law enforcement immediately. Verifying that a complainant, facility, and/or covered individual(s) has made a report to law enforcement would include review and confirmation of the following information: • Who submitted the report to law enforcement, including name and contact information; • Who did the reporter contact, including law enforcement entity, name, and contact information; • Date/Time that the report was filed; • Any copies of the report made to law enforcement, if available; • What information was conveyed to law enforcement; and • The police report number provided by law enforcement. When the SA or CMS location confirms noncompliance related to abuse, the SA or CMS location must report the cited finding of noncompliance to local law enforcement and, if appropriate, the Medicaid Fraud Control Unit. NOTE: “Covered individual” is defined in section 1150B(a)(3) of the Act as anyone who is an owner, operator, employee, manager, agent or contractor of the facility (§483.12(b)(5)(i)).